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Physician Administered Drugs

Under the Medicaid Drug Rebate Program, manufacturers are required to provide rebates on drugs paid for by a State. To receive rebates, States must identify the drugs by their national drug code (NDC). The Department has been requiring providers to submit the NDC on claims with the correct J-Code. The crosswalk the Department uses to verify this information can be found at the following link:

This list does not provide the rebatable drug list. Please speak with the pharmacy or wholesaler that you work with to make sure the product you are buying is rebateable. You can find a drug list on the CMS website, this list contains the participating manufacturers and the drugs by NDC that are rebatable. https://www.medicaid.gov/medicaid/prescription-drugs/medicaid-drug-rebat... .

If the drug you are providing in your office is not rebatable you must have an approved prior authorization to receive payment. It will be a denied claim line if the NDC does not match the J-Code and if the NDC is non-rebatable.